Patne en Aksyon (Partners in Action) is a well-established campus community partnership between the University of Miami and key Haitian community-based organizations in South Florida. Over the past four and a half years, Partnership members have been actively engaged in a Community-based Participatory Research (CBPR) initiative to address the disproportionate burden of cervical cancer in Little Haiti, the predominately Haitian neighborhood in Miami. Cervical cancer incidence and mortality rates in Little Haiti are significantly higher than elsewhere in the Miami metropolitan area, including other, low income, minority neighborhoods. As part of our effort to attenuate this disparity, we have learned about twalet deba, a feminine hygiene practice designed to cleanse, dry, and tighten the vagina for disease prevention and enhanced sexual pleasure of male partners. We believe, though have not yet empirically verified, that this practice may actually increase susceptibility to Human Papillomavirus (HPV), the principal cause of cervical cancer. The proposed research aims to fill this gap in understanding. We have planned a two-year exploratory study that integrates mixed methodologies. Indigenous Community Health Workers, or Ajan Fanm, will collect all study data. Integrating the Ajan Fanm into our study design is consistent with the tenets of CBPR and essential for achieving study aims, given their intimate knowledge of cultural norms related to the discussion of health and other sensitive topics. In the first phase of research, the Ajan Fanm will employ participant observation and in-depth interviewing techniques to better understand the socio-cultural significance of twalet deba, and how this practice is intricately tied to male-female relationships, lay perceptions of health and illness causation, and sexuality. Information learned from these data will inform the second phase of the proposed research. In this phase of inquiry, the Ajan Fanm will interview 250 Haitian women, and teach them to use a simple self- sampling device to collect a cervical specimen for HPV testing and cytology. This device has similar efficacy to the Pap smear, but it can be self-administered in the privacy of one's home, circumventing socio-cultural concerns about modesty prevalent among Haitian women. The cervical specimens will be evaluated by a certified pathologist for cytologic changes and tested for HPV using the Hologic/Third Wave Invader assay. In this exploratory study, our primary objective is to improve understanding about twalet deba and its potential association with HPV to inform future research and intervention that may attenuate the excess risk of cervical cancer in Little Haiti and other medically underserved, ethnic enclaves.